Safe management of paediatric penetrating head injury without a CT scanner: A strategy for humanitarian surgeons based on experience in southern Afghanistan

Annals of the Royal College of Surgeons of England
P MathewD Gentleman

Abstract

In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. All cases of children aged under 16 years with penetrating head injury who were treated in a trauma unit in southern Afghanistan by a single neurosurgeon between 2008 and 2010 were reviewed. Based on a previously published retrospective review, a clinical strategy aimed specifically at generalist surgeons is proposed for selecting children who can benefit from surgical intervention in environments with no access to CT scanners. Fourteen patients were reviewed, of whom three had a tangential wound, 10 had a penetrating wound with retained fragments and one had a perforating injury. Two operations for generalist surgeons are described in detail: limited wound excision; and simple decompression of the intra-cranial compartment without brain resection or dural repair. In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for ...Continue Reading

References

Mar 15, 1975·British Medical Journal·D S Gordon
Jan 1, 1992·Injury·R M Coupland, P E Pesonen
May 1, 1973·The Journal of Surgical Research·M C RobsonT J Krizek
Mar 1, 1974·The British Journal of Surgery·D P ByrnesC A Gleadhill
Jun 1, 1970·Journal of Neurosurgery·A J Raimondi, G H Samuelson
Nov 22, 2000·The Journal of Trauma·M B ShapiroM F Rotondo
Jan 6, 2001·Journal of the Royal Army Medical Corps·D M BowleyK D Boffard
Apr 20, 2001·Journal of the Royal Army Medical Corps·I G Cullis
Apr 20, 2001·Journal of the Royal Army Medical Corps·P F HillG W Bowyer
Apr 20, 2001·Journal of the Royal Army Medical Corps·J Clasper
Apr 20, 2001·Journal of the Royal Army Medical Corps·P Dearden
Jan 13, 2006·Plastic and Reconstructive Surgery·Kiya MovassaghiMichael J Yaremchuk
Feb 14, 2007·The Journal of Trauma·John B HolcombJohn R Hess
Jul 16, 2008·Journal of the Royal Army Medical Corps·T J HodgettsE Kirkman
Jun 9, 2009·BMJ : British Medical Journal·Jan O JansenAdam Brooks
Jun 24, 2010·Neurosurgical Focus·Randy S BellRocco A Armonda
Jun 24, 2010·Neurosurgical Focus·Frederick L StephensRocco A Armonda
Mar 1, 2013·British Journal of Neurosurgery·P MathewM F Eisenburg

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.

© 2022 Meta ULC. All rights reserved